Smoke and Mirrors in the E-Cigarette Debate

“Smoking Kills” is written in bold letters on cigarette packs. Warnings about the harmfulness of smoking are mandatory in many countries today. In fact, 2014 marks 50 years since the U.S. Surgeon General’s report on smoking emphasized the significantly increased mortality associated with the habit.

Yet smoking prevalence remains stubbornly high, around 30% to 40% among adult males below age 60 in both developed and developing countries. The comparable rates for females are about 20% in developed countries and below 10% elsewhere.

Perhaps that’s sufficient reason to embrace any development that could help millions to quit. Or is it?

So-called electronic cigarettes have been around for some years now. They were advertised as a way to stop smoking. Moreover, they may be used in public places where law bans tobacco smoking. Now, e-cigarettes are hailed as the “healthier option”. After all, only nicotine is consumed, and not thousands of chemicals of which almost one hundred are cancer-causing.

It’s not that simple. Inhaling nicotine via e-cigarettes requires a polyethylene glycol mist and the long-term risks around inhaling this are unknown. Furthermore, e-cigarettes are not designed to change the actual habit of smoking. The devices look like cigarettes; they still contain addictive nicotine, and smoking them will not stop the craving for regular cigarettes.

In fact, e-cigarette ads hail a new area of nicotine consumption, providing 100% satisfaction - this time with a high-tech device that appeals to young, socially active men and women. With this approach, a wider population of users is being targeted that includes ex- and non-smokers as well as actual smokers.

What are e-cigarettes in the eyes of the authorities? Some categorise them as tobacco products and others as drug-delivering devices. Earlier this year the European Union agreed on a new Tobacco Product Directive that entered into force on May 19, 2014. Within two years all member states must implement the directive into national legislation.

Depending on nicotine concentration or the advertised purpose, e-cigarettes will in future be treated as medical devices that will only be sold in pharmacies or as tobacco products. E-cig packs will include a warning highlighting its toxicity, such as “This product contains nicotine, which is a highly addictive substance”.

Of course, if the long-term side effects of the inhalation process are benign, a trend away from smoking tobacco toward using e-cigarettes could be seen as a positive development. In that case, the mortality of e-cigarette users versus smokers could improve significantly.

On the other hand, it could become “chic” for a large proportion of adolescents to start using e-cigarettes, with all the negative consequences of nicotine addiction. In that case, underwriting guidelines for life and health insurance will have to be adjusted accordingly.